title: The relative and combined ability of high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide to predict cardiovascular events and death in patients with type 2 diabetes.
abstract: OBJECTIVE Current methods of risk stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS Seven hundred nine (18%) patients experienced a major cardiovascular event (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and 706 (18%) died during a median of 5 years of follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio for cardiovascular events for NT-proBNP was 1.95 per 1 SD increase (95% CI 1.72, 2.20) and the hazard ratio for hs-cTnT was 1.50 per 1 SD increase (95% CI 1.36, 1.65). The hazard ratios for death were 1.97 (95% CI 1.73, 2.24) and 1.52 (95% CI 1.37, 1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39% for NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination. CONCLUSIONS NT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
authors.affiliation: Corresponding author: Graham S. Hillis, ghillis@georgeinstitute.org.au.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain